Provider Demographics
NPI:1699836528
Name:JOHNSON, CANDACE ANN (LMSW ACSW CTS)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW ACSW CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:402 THORNTON ST
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-0339
Mailing Address - Country:US
Mailing Address - Phone:269-795-2243
Mailing Address - Fax:269-795-5315
Practice Address - Street 1:402 THORNTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-0339
Practice Address - Country:US
Practice Address - Phone:269-795-2243
Practice Address - Fax:269-795-5315
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082216104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker